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This qualitative study is about barriers to the utilization of HIV testing as perceived by African Americans who have recently used cocaine and who live in the rural Delta region of Arkansas. Affordability, physical accessibility, and geographic availability were not perceived as barriers to HIV testing in this sample, yet acceptability was still perceived as poor. Acceptability due to social mores and norms was a major barrier. Many said testing was unacceptable because of fear of social costs. Many were confident of being HIV-negative based on risky assumptions about testing and the notification process. Small-town social and sexual networks added to concerns about reputation and risk. System approaches may fail if they focus solely on improving access to HIV services but do not take into consideration deeply internalized experiences of rural African Americans as well as involvement of the community in developing programs and services.

The objective of this research was to examine whether users of mental health or substance abuse (MH/SA) services incurred greater costs for non-MH/SA services than nonusers of MH/SA services. Two years of health care utilization data were collected on 443 at-risk drinkers from six southern U.S. states. We then examined predictors of using MH/SA services and costs associated with non-MH/SA services. The results showed that use of MH/SA services was associated with female gender, military service, health insurance, and not being employed full-time. Unadjusted analyses indicated that non-MH/SA service costs were significantly higher among MH/SA service users than nonusers. However, this association did not endure in multivariable models. In fact, emergency department costs were significantly lower among MH/SA users. It is commonly assumed that users of MH/SA services are also heavy users of other medical services. Through multivariable models, this study found that overall costs of non-MH/SA services were similar between users and nonusers of MH/SA services.

This article describes rural methamphetamine (MA) production ('cooking") and associated risks in Kentucky and Arkansas. It is based on qualitative interviews with 36 active MA users and one former user, a population that included 10 MA "cookers." Participants reported that various forms of the Birch cooking method have become widespread locally over the past decade. There is an underground market in MA ingredients like pseudoephedrine pills and anhydrous ammonia and innovative methods to overcome restrictions on obtaining them. MA production is hazardous. Explosions, chemical spills, and injuries are associated with acquiring anhydrous ammonia. MA cooking is often undertaken by the inexperienced, those "high" on MA, or people who rush production because of fear of discovery or craving for the drug. Consequently, accidents and injuries sometimes occur. Lab waste is also a potential danger. Our preliminary findings can inform future research and the development of educational programs that address MA cooking and associated problems.

In this article, we show that the Veterans Health Administration (VA), similar to military organizations, is a gendered organization where women Veterans' experiences are embedded in and shaped by gender inequalities and structures of power. Based on an in‐depth analysis of women Veterans' substance use histories and VA treatment seeking experiences, we illustrate how gender power dynamics are (re)produced and maintained through everyday social interactions and organizational practices and processes that render women Veterans both visible and invisible: visible as sexual objects and invisible as suffering subjects. By retelling the illness and treatment experiences of women Veterans with trauma histories and co‐occurring substance use and mental health disorders—a highly stigmatized population of Veterans—we highlight the importance of giving voice to their concerns when developing policies and programs to address the unique health care needs of women Veterans.

Objectives. To determine if military leader behaviors are associated with active component and Reserve–National Guard servicewomen's risk of sexual assault in the military (SAIM) for nondeployed locations.

The purpose of this study was to examine HIV-related beliefs of rural African American women who use stimulant drugs and their perceived risk for acquiring HIV. Qualitative interviews were conducted with 15 African American women living in the Mississippi Delta region of rural Arkansas. All women in the study were active users of crack and/or powder cocaine. We used the qualitative methods of content analysis and constant comparison to analyze the transcribed interviews. Four major themes emerged from the analysis: 1) Knowledge and Beliefs, 2) Don't Ask, Don't Tell, 3) Staying Safe, and 4) Surviving in the Community. Based on participants' responses, we discuss implications for framing new risk-reduction interventions tailored to the specific needs of this high-risk population at both the individual and community levels.